Now Children Need Cholesterol Tests, Too

Children today are growing up fast — so fast that they're now being told to have their cholesterol tested before they hit puberty.

The new recommendation to test all children for cholesterol at ages 9 to 11 comes from the National Heart, Lung, and Blood Institute. The goal is to reduce the risk of heart disease in adulthood. But the new recommendation runs counter to the advice of another federally-funded independent panel, which says routine screening isn't needed before age 20.

"The more we learn the more we realize that the atherosclerosis process really begins early in life," says Steven Daniels, chair of the panel that wrote the new guidelines, and a pediatric cardiologist who chairs the department of pediatrics at the University of Colorado School of Medicine. The earlier in life cholesterol risk can be identified, the premise goes, the easier to keep it under control.

Pediatricians were already supposed to be doing cholesterol tests in children who are obese, have diabetes or have a family history of heart disease. But after studies found that those screening tools weren't catching some grade-schoolers with high cholesterol, the notion of universal screening gained traction.

Kids won't like it, because it requires a blood draw, and that means a needle. But the test won't require a special visit; it will be part of regular well child visits. The new guidelines are endorsed by the American Academy of Pediatrics is publishing them Monday in the journal Pediatrics.

But the new recommendation isn't universally endorsed. Some doctors think the call for universal screening is overkill, since only about half of children with high cholesterol will go on to have that problem as adults. And researchers at the Centers for Disease Control and Prevention reported last year that in many children, high levels of LDL cholesterol corrected themselves by the next office visit.

A 2007 recommendation from the U.S. Preventive Services Task Force, a federally-funded group that sets practice guidelines, says there's not enough evidence to recommend universal screening under age 20.

Daniels says that universal screening is intended to find children with very high LDL cholsterol, the "bad" kind, is 190 milligrams of the stuff in each decliter oof blood. Overall, less than 1 percent of children would be candidates for treatment with statin drugs, he says. "I don't think it's likely that there will be overtreatment."

More likely is that Mom and Dad will need to get serious about exercise eating healthy. Daniel says: "It gives them a stronger rationale for working hard on making the home the healthiest environment that it could be."

Even though statins have an enviable safety record in adults, no studies have been done on the implications of putting children on statins for the rest of their lives. That's why today's recommendation gives some physicians pause.